- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $2,472.00 / $4,991.00
| Facility | | $756.00 | $2,472.00 | $4,991.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $9,302.26 / $9,302.26 / $9,302.26
| Facility | 50 | $9,302.26 | $9,302.26 | $9,302.26 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $761.13 / $761.13 / $962.35
| Facility | 52 | $761.13 | $761.13 | $962.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,844.18 / $8,169.73 / $18,385.55
| Facility | | $3,844.18 | $8,169.73 | $18,385.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,585.00
| Facility | | $746.00 | $2,415.00 | $6,585.00 |